Health Care Service Corp. v. Walgreen Co.

2023 IL App (1st) 230547, 249 N.E.3d 481
Appellate Court of Illinois·Decided August 30, 2023·No. 1-23-0547·Published·Cited by 4 cases

Opinion

2023 IL App (1st) 230547

FIRST DISTRICT

THIRD DIVISION

August 30, 2023

No. 1-23-0547

HEALTH CARE SERVICE CORPORATION, a ) Appeal from the Mutual Legal Reserve Company, ) Circuit Court ) Cook County.

Plaintiff, )

)

v. )

) No. 21 L 000621

WALGREEN COMPANY and WALGREENS BOOTS ) ALLIANCE, INC., )

)

Defendants and Third-Party Plaintiffs-Appellants )

)

)

)

(Prime Therapeutics LLC, ) Honorable ) Caroline K. Moreland, Third-Party Defendant-Appellee). ) Judge Presiding.

PRESIDING JUSTICE McBRIDE delivered the judgment of the court, with opinion.

Justices Reyes and Van Tine concurred in the judgment and opinion.

OPINION

¶1 This appeal case arises from the circuit court’s order staying two indemnification counts filed by third-party plaintiffs/defendants, Walgreen Company and Walgreens Boots Alliance, Inc. (collectively, Walgreens), against third-party defendant, Prime Therapeutics LLC (Prime). In the underlying action, plaintiff, Health Care Services Corporation (HCSC), filed a complaint seeking damages for fraud, fraudulent nondisclosure, unjust enrichment, and related claims based on allegations that Walgreens had engaged in a knowing and intentional scheme of improperly reporting artificially inflated rates for prescription drugs dispensed to persons who had health

insurance through HCSC. HCSC further alleged that Walgreens inflated prices on millions of claims and obtained inflated reimbursements from HCSC.

¶2 Walgreens filed the third-party complaint at issue against Prime seeking contribution and indemnification for any judgment entered against Walgreens in the underlying action. Prime filed a motion to dismiss the third-party complaint under sections 2-615 and 2-619 of the Code of Civil Procedure (735 ILCS 5/2-615, 2-619 (West 2020)). The trial court dismissed the contribution counts with prejudice and stayed the indemnification counts until HCSC’s claims are resolved in the underlying action. 1

¶3 Walgreens appeals, arguing that the trial court erred in staying its indemnity claims for several reasons: (1) the stay was against the public policy of simultaneous adjudication of third- party claims with the underlying claim, (2) the court improperly held that a stay was mandatory, (3) Prime did not properly move for a stay, (4) Prime failed to satisfy its burden by clear and convincing evidence, and (5) Walgreens’s anticipatory repudiation claim is ripe for adjudication and not contingent on the resolution of the underlying claim.

¶4 Multiple cases have been filed against Walgreens related to the alleged misrepresentation of drug reimbursement prices, including the underlying case here and a consolidated federal case filed in the District Court for the Northern District of Illinois. See BCBSM, Inc. v. Walgreen Co., No. 20 C 1853, 2022 WL 393596 (N.D. Ill. Feb. 9, 2022). In the federal case, Walgreens also filed a third-party complaint alleging contribution and indemnification against Prime, which the district court dismissed in February 2022. See id. Specifically, the court found the indemnification counts were premature because Walgreens had not yet incurred any liability in the underlying case. Id. at *10.

The contribution counts are not part of the appeal and thus are only discussed as necessary for an 1

understanding of this appeal.

¶5 HCSC filed its complaint against Walgreens in January 2021. HCSC administers and underwrites health plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. Walgreens has been a network pharmacy for HCSC, which means that members of HCSC’s health plans could use their prescription drug benefits at Walgreens stores and receive in-network pricing. Walgreens also offers a “Prescription Savings Club” (PSC) program, which makes prescription drugs more affordable for uninsured and underinsured consumers in the PSC.

¶6 When Walgreens dispenses a prescription to a health plan member, an electronic claim for reimbursement is sent to an intermediary, a pharmacy benefit manager (PBM). The PBM would then submit a claim for payment to HCSC. Prime was the PBM at all relevant times in the underlying action, which meant that HCSC paid Walgreens through Prime. HCSC alleged that Walgreens made false statements and omitted material facts about its usual and customary (U&C) prices, i.e., the cash price of a prescription drug paid by an individual without insurance. The U&C price is the ceiling for a prescription drug. HCSC contended that Walgreens should have included the prices available to PSC members. HCSC further alleged that Walgreens knowingly and intentionally submitted inflated U&C prices for brand and generic drugs purchased by HCSC’s members and caused hundreds of millions of dollars in excess reimbursements to be paid on claims from Walgreens. The underlying action remains pending in the circuit court.

¶7 In May 2022, Walgreens filed its third-party complaint for contribution and indemnification against Prime. Walgreens alleged that Prime was a joint tortfeasor in the underlying fraud claims and shares responsibility for some or all of HCSC’s harm. As HCSC’s intermediary, Prime adjudicates Walgreens’s reimbursement claims on HCSC’s behalf and determines each claim’s appropriate disposition under the health plan’s coverage standards.

Walgreens further asserted that it “neither transmits its U&C prices directly to [HCSC] nor receives reimbursements directly from [HCSC].” Walgreens transmits a U&C price and other claim-related information to Prime, Prime then allegedly transmits a U&C price and other claim- related information to HCSC, HCSC sends a reimbursement to Prime, and finally Prime sends the reimbursement to Walgreens.

¶8 Walgreens further alleged that due to its role as the intermediary, Prime knew and understood how both Walgreens and HCSC defined U&C prices and how much HCSC paid Walgreens for any reimbursement claims. The third-party complaint asserted that Prime was aware of Walgreens’s U&C price reporting policies and practices and adjudicated Walgreens’s reimbursement claims using Walgreens’s allegedly false U&C prices, proximately harming HCSC and contributing to HCSC’s loss.

¶9 The third-party complaint alleged multiple counts for contribution and indemnification, including five counts for contribution (one count for each state in which HCSC operates, i.e., Illinois, Oklahoma, Texas, New Mexico, and Montana) and two counts for indemnification, one seeking a declaratory judgment and the other based upon a claim of anticipatory repudiation. Since this appeal only involves the indemnification counts, we address the allegations in the complaint for those two counts.

¶ 10 Both the declaratory judgment and anticipatory repudiation indemnification counts are based on the same allegations. The relationship between Walgreens and Prime is governed by a contract, dated March 1, 2008 (2008 contract). Section 8.2 of the 2008 contract contains an indemnification clause in which Prime agreed to:

“indemnify and hold [Walgreens] harmless from and against all claims or suits asserted by a third party(ies) and related losses, damages and expenses, including

but not limited to reasonable attorney[ ] fees, costs and expenses to the extent they are arising out of or resulting from Prime’s breach of or any negligent act or omission of Prime relating to this Agreement.”

The 2008 contract defines U&C as “the amount charged to a cash customer by the dispensing pharmacy at the time of dispensing *** exclusive of sales tax charged to a Covered Person or other discounts that do not affect the total reimbursement amount claimed.”

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Health Care Service Corp. v. Walgreen Co., 2023 IL App (1st) 230547, 249 N.E.3d 481 (Ill. Ct. App. 2023).

2023 IL App (1st) 230547 (Health Care Service Corp. v. Walgreen Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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